Background: Bevacizumab, a monoclonal antibody targeting VEGF-A, is a cornerstone in ovarian cancer. Bevacizumab is associated with renal adverse events, including hypertension, proteinuria, and acute kidney injury. The incidence, risk factors, and prognostic impact of these renal events remain poorly defined. This study aimed to determine the incidence, risk factors, and association with mortality of renal events in patients with ovarian cancer treated with bevacizumab. Methods: We conducted a retrospective single-center study including 147 patients with ovarian cancer treated with bevacizumab between 2011 and 2023. Renal events were defined as new-onset or worsening hypertension (grade ≥2), proteinuria (grade ≥2), and/or acute kidney injury, as per CTCAE v5.0 and KDIGO guidelines. Results: Over a median follow-up of 52 months, 34.7% of patients developed a renal event, most commonly hypertension (27.9%), followed by proteinuria (6.8%) and acute kidney injury (6.8%). Only a history of hypertension was identified as an independent risk factor for renal event (p=0.0078). Importantly, patients with renal events had significantly longer survival compared to those who did not (p=0.0243). In the multivariate analysis, the occurrence of a renal event emerged as a protective factor against mortality. Conclusions: In conclusion, renal events occurred in 34.7% of bevacizumab -treated patients. Hypertension was a risk factor for renal event, but renal events appeared to be a protective factor against mortality. Rather than signaling harm, their presence may reflect effective VEGF pathway inhibition and greater antitumor response. Routine monitoring and early nephrological management of hypertension, proteinuria, and acute kidney injury are essential to optimize treatment continuity and outcomes.
Riaza et al. (Fri,) studied this question.